What is My Risk of Getting High Altitude Sickness?

In this post we offer you a practical way to reduce your risk of getting high altitude sickness when you travel to Tibet (or any other high altitude destination.) First we’ll define what high altitude actually means and give you some examples in Tibet. Second we will look at what kind of thing put you at risk. Third we will summarize the risk factors for getting high altitude sickness and provide for each category an example of a route in Tibet. At the end, we offer a “Highlights” section to give you an idea of the most important takeaway lessons from this post.

Sershul Monastery in Kham, Eastern Tibet, at 13,000 feet/4000 meters.

If you’re panning a trip to Tibet, you should also know that no independent travel is allowed to Tibet and you must work with a travel agency. We advise that you choose a Tibetan-owned agency, which hires Tibetan guides only. The simplest way to do this is ask us to connect you to a reliable Tibetan-owned travel agent to plan a great trip for you that also supports the local Tibetan economy and culture. (Unfortunately, we cannot help Indian passport-holders traveling to Mount Kailash.)

Definition of High Altitude

To start with, it is helpful to know what altitudes are considered “high.” Although definitions vary, we like the below as a good working definition in relation to high altitude sickness:

High altitude: 8000 to 12,000 feet/2438 to 3658 meters

Very high altitude: 12,000 to 18,000 feet/3658 to 5486 meters

Extreme high altitude: above 18,000 feet/5486 meters

It is uncommon for people to get altitude sickness below 8000 feet (about 2500 meters). However, while it is not common, you should know that high-altitude illnesses “can present as low as 2,000 m” (about 6500 feet). 1

Sample Altitudes in Tibet

To help you understand these altitudes a little better in relation to your Tibet travel, here is a small sample of the elevations of common tourist destinations in Tibet. (Later in this series of posts on altitude sickness in Tibet, we will list the altitudes of some common itineraries of Tibet travelers.)

High

Lhasa 11,975 feet/3650 meters (note that this is borderline high/very high altitude)

What puts you at Risk for High Altitude Sickness?

Every traveler has a different risk profile for getting altitude sickness. Different people taking the exact same trip will each have a unique response to high altitude based on individual genetics.

We know that some people are more likely to get sick than others, but you have no way of knowing if you are among those who might get altitude sickness without going to high altitude. If you have gotten altitude sickness before, you are more likely to be sick again, but this does not happen in every case. (In the same way, if you did not get sick on one trip to high altitude, you are not guaranteed to be healthy on following trips.)

Physical Fitness and Age

Physical fitness and age have little effect. Children are as likely to get it as adults. Somewhat surprisingly, people over 50 have a slightly lower risk. If anything, it appears that young, fit people may be at greater risk of getting serious altitude sickness due to a tendency to go too high too fast, pushing through the early warning signs of AMS [Acute Mountain Sickness]. (This observation about young people is based on reading a lot of the literature on altitude sickness, not on a clinical trial.)

Rate of Ascent

You have no control over your genetically based susceptibility to getting altitude sickness, but fortunately there is a second major factor over which you do have considerably more control – the rate of ascent. Ascending high and fast has a high correlation with getting altitude sickness. (See the post on How to Avoid Altitude Sickness for more detail.)

Even with the uncertainty of individual genetic susceptibility to altitude sickness, experts have determined some basic risk factors for high altitude sickness.

Low Risk

People who have not had altitude sickness before ascending to less than ~ 9100 feet/2800 meters.

People who take at least 2 days to ascend to 8200-9800 feet/2500-3000 meters, and who

don’t increase their sleeping elevation more than about 1600 feet / 500 meters a day after reaching 8200 feet/2500 meters, and

take an extra day of rest for acclimatization every 3300 feet/1000 meters (by not ascending any higher that day)

Example of a low-risk itinerary

You need to know that it is very challenging to find a low-risk itinerary for entering Tibet! We will talk about this much more in an upcoming post in this series, but for now here is a sample:

A trip to Amdo (Eastern Tibet) in which you train or fly into Siling/Xining (7200 feet / 2200 meters), sleep in Siling, and take day trips to Kumbum Monastery, Kokonor Lake (Chinese: Qinghai), Guide, Yoningsi Monastery, the Datong Forest and Cha Han Hotsprings.

Important note: This is a low-risk option for visiting Tibet, but is not, at the same time, one of the classic itineraries that many people wish to make. In this post on recommended itineraries, we explore other strategies for visiting some of the major destinations in Tibet without putting yourself at high risk.

Moderate Risk

People who have not had altitude sickness before ascending to between 9200 feet/2800 meters and 11,400 feet/3500 meters in one day.

People who have had AMS previously, and who ascend to 8200-9200 feet/2500-2800 meters in one day.

Example of a moderate-risk itinerary

A visitor on a second trip to Tibet who experienced mild AMS in Lhasa on her first trip now flies from Chengdu into Dartsedo (Chinese: Kangding, 8500 feet/2590 meters). If she remains in Dartsedo for 2-3 days to acclimate, the risk would remain moderate, but if she were to move on to Lhagang (Chinese: Tagong, ~ 12,000 feet/3700 meters) on her first day, her risk would increase to high. See the next section.

High Risk

Anyone ascending to more than 11,400 feet/3500 meters in one day.

Anyone who ascends more than 1600 feet/500 meters per day in sleeping elevation at altitudes above 11,400 feet/3500 meters.

People who have had AMS previous, and who ascend to ~ 9200 feet/2800 meters or more in one day.

Anyone who has already had HAPE or HACE.

Example of a high-risk itinerary

Flying from near sea level (like Beijing, Shanghai or Chengdu) into Lhasa.

Important note: Of course this is one of the most popular ways of getting to Tibet. We explore some alternatives strategies in this post on itineraries for acclimatizing in Tibet in which we try to identify good routes. (It isn’t easy in Tibet!)

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